| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
672 |
606 |
$56K |
| V2020 |
Frames, purchases |
729 |
652 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
685 |
617 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
355 |
307 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
657 |
598 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$500.85 |